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File a claim against the Workers' Compensation Trust Fund (WCTF)

Find out how to file a claim with the Department of Industrial Accidents (DIA) if your employer does not have workers’ compensation insurance.
You should get a notice within 1 – 2 weeks after submitting your claim.

Contact

Public Information Office

Phone

(857) 321-7470

Phones open M-F 8 am - 5 pm

TTY (800) 224-6196

Phones open M-F 8 am - 5 pm

Toll Free In Massachusetts Only (800) 323-3249

Phones open M-F 8 am - 5 pm.

Online

Info2@mass.gov

The Details

What you need

To file a workers’ compensation claim with the Department of Industrial Accidents (DIA) against the Workers’ Compensation Trust Fund (WCTF) you will need to know:

  • Your date of injury, illness, or death if a dependent is filing for benefits
  • The 1st calendar day of work you missed
  • The 5th calendar day of work you missed
  • The body parts and types of injuries
  • What type of benefits you are looking for
  • How long you may be out of work, if known
  • Where you first went for treatment
  • Your current treating doctor

If you file a claim seeking weekly compensation benefits, you're required to attach a copy of a doctor's report or record not more than 6 months old that describes the extent and length of time of your physical or emotional incapacity for work. This report must also relate your incapacity to your claimed industrial injury.

You are also required to attach a Certificate of No Insurance and DIA Form 170 - Affidavit of Employee in Application for Trust Fund Benefits.

How to file

To file a claim against the WCTF, you, or your attorney, will need to file 3 documents and any supporting documentation as required:

To verify that your employer has no workers’ compensation insurance.

1. Download and fill out an Insurer Request Certification Form. Mail the form to:

                         Tom Finneran
                         Office of Insurance
                         Department of Industrial Accidents
                         19 Staniford St., 5th Floor
                         Boston, MA 02114

  • Or submit the request electronically at: https://www.mass.gov/doc/insurance-inquiry/download

  • This form verifies that the employer has no workers' compensation insurance coverage. The Office of Insurance will send a certified letter called a Certification of No Insurance back.

2. Download and fill out the Form 170 – Affidavit of Employee in Application for Trust Fund Benefits.

3. File the Form 110 via your online account.

  • Send supporting documents, Certification of No Insurance, and Form 170 – Affidavit of Employee in Application for Trust Fund Benefits to: Department of Industrial Accidents FAX (617) 727-4551 or email dia-docattach@mass.gov

4. Also send hard copies of all documents by certified mail to:

                     Workers’ Compensation Trust Fund
                     c/o Department Industrial Accidents
                     Lafayette City Center
                     2 Avenue de Lafayette
                     Boston, MA 02111-1750

5. Keep a copy for your records.

Next steps

Notification and investigations

You will be contacted by a claims representative and an investigator from the DIA to discuss your claim.

You will receive a notice from the DIA regarding a conciliation for your claim. A conciliation is the first step in the dispute process. 

Contact

Address
Boston DIA
Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
Directions 
Phone
(857) 321-7470

Phones open M-F 8 am - 5 pm

TTY (800) 224-6196

Phones open M-F 8 am - 5 pm

Toll Free In Massachusetts Only (800) 323-3249

Phones open M-F 8 am - 5 pm.

Online
Info2@mass.gov
Fax
(617) 727-7470
Address
Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
Directions 
Phone
(857) 321-7493
Online
Francisco.Pena@mass.gov
Address
Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
Directions 
Phone
(857) 321-7350
Online
Patrick.Ronan@mass.gov
Fax
(617) 727-6659

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